Assisted Living

Nov 182013
 
Read more about my drinking problem below.

Read more about my drinking problem below.

It is time for my annual update of “Chronicles of Disability.” However rather than simply cover the changes that have happened this year, I have decided to add some new content. This is partially due to my work on a new book I am writing which will tell the story of the journey (or should I say forced march) that my wife and I traveled through the jungles of disability. My own struggle with inclusion body myositis began in 1985, 11 years before I was formally diagnosed, and it continues to this day.

Part of the new content is a gallery of photographs, some new, some from earlier posts on this blog. My goal is to eventually put the entire visual record of my attempts to adapt to inclusion body myositis in one place, organized in chronological order.

This past year has been very difficult. It began with grieving for my wife who lost her battle with myotonic muscular dystrophy October 11, 2012. That grieving process will probably never end although it does change and has become less intrusive on my daily life. During that time I have also experienced the worst decline of physical function of any previous year. Most of that physical loss has been focused on my shoulders, arms and hands. I can no longer hold a Beefeater on the rocks, a Johnny Walker Black with a twist of lemon, a Cadillac Margarita, or even a glass of Petite Syrah. I also can’t hold a glass of water, but that seems to be a minor inconvenience by comparison. Dressing myself is now completely out of the question as is holding a camera or picking anything up from the table, bed or floor. Eating has been reduced to a process resembling a scene from a Monty Python movie. Getting anything from a plate to my mouth involves a slinging motion that frequently sends food flying in unexpected directions.


Now before this pity party gets out of control, I should point out that I continue to find ways to adapt. For example, there is a terrific acrylic beverage cup on Amazon that I use for coffee, whiskey, and wine. It is lightweight, has a handle that fits my hand perfectly and is relatively inexpensive. I can sling it through the air, provided it is only half-full, and generally get it pretty close to my mouth. (There is a slightly larger mug that I use for water.) As to the photography, that problem was solved when I purchased my GoPro and installed the iPhone app to control it. (See an earlier post.) Eating remains an unresolved challenge although I would rather put up with a messy aftermath then resort to being fed. I can only imagine how the pressure to eat quickly and my swallowing problem would combine, with serious consequences no doubt.


Voice recognition continues to get better with each iteration. Now my new iMac with its Mavericks operating system has built-in voice recognition that is almost as good as Dragon Dictate but has the advantage of being launched immediately by simply pushing the function key twice. I still use Dragon Dictate for the longer projects such as this post.

Jun 282013
 

Dear bidet, you have no idea how much I have missed you for the past 24 hours.

After struggling with inclusion body myositis for more than 17 years, it was a bout of constipation that finally sent me to the hospital. After 17 days, I owed too large a debt to my toilet to ignore the problem any longer.

I checked into Scripps Green Hospital late in the afternoon. I was in my Permobil C500 power chair, but I was forced to abandon that for a gurney. The hospital staff seemed shocked when I told them that I could not stand up and transfer, they would have to find a way to lift me. A Hoyer lift I suggested. They shook their heads. “We will get a lift team,” one orderly said.

Silly me, I expected to see a few rejects from the San Diego Chargers show up. Instead, it appeared that their lift team consisted of anyone who was not on break at the moment. I tried to explain that I had contractures on my left arm and left leg and that I would be no help whatsoever, not because I did not want to, but because I could not. Nevertheless, they each grabbed a limb and said “one, two, three!” and lifted. I have a fairly high tolerance for pain, and even when something really hurts I try not to make too much of it. I literally screamed out loud at the top of my lungs. But on a positive note, they didn’t drop me to the floor. This process was repeated when they transferred me to the x-ray table, then transferred me back, then to my final destination––a bed in room 466.

At last! Oh how wrong I was. You see in order to cure my bout of extreme irregularity they were going to administer “GoLghtly” which is mostly used to prepare for a colonoscopy. It makes you Go, but certainly not Lightly. In my case it was a way to force the issue. After drinking a couple of quarts of the stuff, I was ready for the next phase at about 3 am. A nurse’s aide came in response to my call button (eventually) and I explained what was about to happen. She extended her arm and wondered if I needed help to the toilet. Obviously the second shift had not been told about my condition. When I told her that I could not walk, stand, or even roll from side to side, she left quickly in search of help. Help consisted of two more aides and a bedpan.

Their technique was simple, but brutal. They would shove me to one side of the bed, rolling me in the process, then put a very uncomfortable plastic thing beneath and roll me back the other way so that I was perched on top of it. Now my pain was complete. In order to shut me up, they brought in several more pillows and placed them in areas that bothered me the most. Of course the entire process had to be repeated to remove the pan. And both processes were repeated five more times during the night.

By morning, I was declared “fixed” and a nurse asked if I would like to have breakfast. You would not think I could have an appetite after all that, but since I had not eaten for nearly 24 hours, I let them bring it to me. I don’t need to tell you what hospital food is, but fortunately it was not possible for me to eat any of it. My dysphagia means I must be sitting upright but the hospital bed wouldn’t take me to that position.

“Can’t you just sit on the edge of the bed with your legs dangling over the side?” the nurse asked. Once again I had to explain about having no upper trunk support. So they put the breakfast on the over-bed table and shoved it up close to my face. Of course I could not raise my arms high enough to even pick up a fork, let alone get something to my mouth. When the nurse returned and saw that I had not eaten anything, she offered to feed me a few bites. A few bites was all it took to send me into violent coughing spasms whereupon she promptly decided I needed a consult with a respiratory therapist and a speech therapist. For that matter, why not also have occupational therapy and physical therapy? (I was on Medicare with a good supplement after all.)

So, for the three hours before lunch, I was visited by all of them plus a case manager, charge nurse, resident doctor, dietitian and nutritionist. Then came lunch and once again they tried to feed me, and once again it was nearly impossible. By then they were ready to fill out my discharge papers and send me home. But there was one last minor detail. They had to get me out of the bed and onto my wheelchair. This time they did get a Hoyer lift, but none of them had used one before, so it was a part scary/comical procedure that lasted for the better part of half an hour and ended with me kind of in my wheelchair.

Now I am back at Huntington Manor, sitting in my very comfortable Permobil, secure in the knowledge that soon my two caregivers will use the overhead ceiling lift to painlessly lift me from the chair and place me in my bed.

I had asked one of the nurses why the hospital was not better equipped to handle people like me. Her answer was that they had all kinds of patients, not just people like me. Of course that is true, however local grocery stores also have all kinds of people shopping there, but that does not prevent them from having wide unobstructed isles, handicap parking out front, and automatic doors. Time and again I read of people complaining about the inaccessibility of healthcare facilities, yet nothing is ever done about it. if I were a little bit younger I might take this up as a cause. It is not that I am too old for the work, it is just that I know I would never see any progress during my lifetime.

Mar 202013
 

A handicap-accessible bathroom.

Every time I explore other assisted living facilities, my bathroom always draws me back to Huntington Manor.

The following is a comment I posted on another blog site. It is in response to an article written by Martin Bayne on Dr. Bill Thomas’s ChangingAging website. Mr. Bayne finds himself in a situation similar to mine. He has begun writing articles advocating for the plight of those of us who need assisted living and for whom there are no satisfactory options. I share his concern and am hoping that I can find a way to add my voice.

I am 72 years old, nonambulatory due to a rare disease (inclusion body myositis), and am living in an assisted living facility. It took me a lot of searching before I could even find one that would accept me. Most said that they would not take care of someone who wasn’t able to stand or walk. My “neighbors” are almost exclusively people 20 years older than me and most are incapable of carrying on a conversation. (no fault of their own, disease and age have damaged important cognitive functions.) The caregivers here are very conscientious, but like most, they are overworked. I am fortunate that I can be my own advocate and thus I get very good treatment.

Every so often, I will check the surrounding area of Southern California to see if something new has arrived that might provide a more stimulating environment. At the end of each search I always return to my room and feel grateful for what I have, because it is fully wheelchair accessible including an enormous roll in shower. Most of the facilities have tiny tub-showers with fiberglass enclosures and little built-in seats that could not possibly accommodate me. As for their “activities” the larger facilities seem to focus on the needs of the least common denominator and provide “sing-alongs” featuring songs from the 40s, bingo, and various childish games. For this, they charge anywhere from $5000 – $7000 per month. By comparison, I like to spend my time studying computer programming via the Stanford University lectures on iTunes. (Or writing this blog.) I know that I am not the only person who is older or disabled but also has a continued desire to learn.

It is obvious that we need a new paradigm for the care of an aging population. As we live longer, more and more of us will develop chronic illnesses that reduce our mobility or our cognitive facilities. In my own case, the ideal solution would be to live in my own home with visiting care givers to get me out of bed and shower and into my wheelchair in the morning and then get me back into bed at night. For most of the day I can be independent except for meals, which I could obtain at a local restaurant or my local microwave. The problem comes from not knowing exactly when I might need help. If I were in bed at night and an emergency arose, what would I do? If, during the day, I dropped something important and couldn’t pick it up, how would I get help? Right now, I can press the pendant that is always around my neck and someone will be around to help me. At home alone there is no such system. The cost of round the clock in-home care is prohibitive and would be a terrible waste of human resources anyway.

My concern is that the movement of for-profit corporations into this field means that any rational and humane solutions will be forever blocked.

Mike Shirk

Since I wrote this article, my circumstances have changed. I was able to find an assisted living facility, Sunrise at La Costa, that was willing to put up with my non ambulatory status and ceiling lift. I wrote about my new residence in this blog article. Since living there I have learned that even one of the best facilities in the area leaves a lot to be desired for providing intellectual stimulation to someone who has no cognitive deficiency. (Well, not beyond the usual deficiencies I have always had, that is.) I will continue to write about this subject because I think it is important to hundreds of thousands if not millions of people in this country and around the world.

Index for series of articles about assisted living.

Introductory article plus updates.

Is it time for assisted living?

Making the decision to move to assisted living, emotionally, practically and financially.

How we chose the facility we did.

Deciding what to take, what to leave, how to adjust our expectations.

What life in assisted living has been like.

How can we make assisted living better for the physically disabled?

Sep 282012
 

Beth on cousin's deck in Englewood, FLA

Beth on the deck of my cousin's apartment on the Gulf coast of Florida, about 39 years ago.

Forty years ago, when Beth and I met, we fell so hopelessly in love we were willing to uproot both of our lives so that we could spend the rest of our years together. We were inseparable, holding hands wherever we went, even on our way to the laundromat where we would sit together and watch our clothes dry. We had two beautiful daughters, now with families of their own. I learned to share her love for art, and we began our retirement intending to spend the rest of our lives painting together. When I became disabled 15 years ago, she helped me cope. Then she became disabled a few years later, as though we needed to share that too.

For the past year or so, Beth has been leaving me. Not out the door or to the arms of another, much farther than that. Her brain is taking her slowly but certainly to a place that I can not visit nor even comprehend. And now this terrible illness, yet to be named despite two weeks of trying by a team of UCSD doctors and psychiatrists, has progressed to the point that the unthinkable is happening. In order for her to receive the kind of care she needs and deserves, she must move to a special facility, and there is no place for me. I can visit as often as I wish, and I will. But when I return to my room, with its ceiling lifts and hospital bed and accessible fixtures, there will be no soft greeting to make this austere environment feel like home. Even worse is knowing that she will also be alone without the hope that I might rescue her from the tigers and lions, snakes and assassins and all the other evil images that come stalking as the light fades. I hope this new place, and new medicine, will make them go away. But even so, I know that the illness has also taken her ability to understand the reasons we are apart. Beth will only know that I am not there, and wonder why the person who once happily spent hours helping her pick curtain fabric has vanished into the murky night.

Aug 042012
 

Note: At the time this series of articles was written, my wife Beth was still with us. She died October 11, 2012.

There is downsizing, and then there is moving to assisted living. Downsizing presents difficult choices of what to keep and what to take with you. Moving to assisted living presents impossible choices.

One way we managed to deal with it was to simply not make many of the decisions. Instead we had our daughters go through our stuff and make a lot of the choices for us, without us being present. Did we agree with every choice? Of course not. But it at least it let us whittle things down to a manageable size.

Another way to approach it is to choose between what you really need and what you think you simply can’t live without. In my case, since I knew I was going to continue to do work in the website design and graphics arts field, I definitely had to take all of my computer gear and cameras. Plus my manuals on software and programming. Beth wanted all of her art supplies, of course.

How do you downsize this?

How do you downsize this?

Clothing was also easier for me, since I really can’t wear standard clothes anymore. I just needed to bring along half a dozen of my specially constructed pants, and a dozen or so shirts. Plus some jackets.

Beth wanted to bring enough to fill several closets so we compromised by storing winter clothes off site and bringing all of her summer clothes. Then we will have to make the switch in the fall and hope we guess right on the weather. I also gave her half of my closet for coats.

Then there are the keepsakes. How could we possibly get rid of any of the vases that people had given us over the years? Well we had to, and every few days we will remember one that would’ve been just perfect for a particular location or occasion. The other really big issue was Christmas decorations. We have been allowed to store some here underneath the facility in their basement, but that still begs the question of what we will do with them come holidays. Perhaps we will be able to use some in a common area here at Huntington Manor.

It’s my belief that the key to this whole process is to try your best to live in the present. Every time we start thinking about things we left behind it becomes difficult. But in truth, nothing we left behind is needed for our daily lives. And the real memories aren’t stored in vases or garment bags. They are in the mind.

Which reminds me to return to working on my first book, “The Society of the Creek.” It is a book about childhood, written for an adult audience. I plan to post some excerpts here.

Index for this series of articles about assisted living.

Introductory article plus updates.

Is it time for assisted living?

Making the decision to move to assisted living, emotionally, practically and financially.

How we chose the facility we did.

Deciding what to take, what to leave, how to adjust our expectations.

What life in assisted living has been like.

How can we make assisted living better for the physically disabled?

Jul 132012
 

Note: At the time this series of articles was written, my wife Beth was still with us. She died October 11, 2012.

Beth and Mike in the Huntington Manor courtyard.

Beth and Mike adjusting to life at Huntington Manor.

I may have over promised when I said the next article would be about adjusting to life in assisted-living. I have always embraced change, and therefore I thought this would just be one more change to assimilate.

I didn’t realize this would be a different kind of change. Most of life is marked with milestones of achievement – moving away from home, graduations, first love, first home, marriage, children, a bigger home, promotions, recognitions, vacations, retirement.

Even the downsizing that goes along with later stages of life can be viewed positively as you are shedding excess baggage, allowing you to have more time for travel and fun.

But this is different. If most of life is like climbing a winding mountain road in a sports car eagerly waiting to see what’s around each turn, what we are going through now is like stalling and coasting back down the mountain in reverse, with the certain knowledge you will never make it back home.

However, blaming assisted living for our sense of loss is like blaming your garage for no longer holding a car. Physical and personal circumstances have altered the trajectory of our lives. Well-meaning family and friends try their best to make us feel like we are still part of their circle, but the truth is we are not. We are part of a completely different life, one that is necessarily highly regulated and predictable.

Mike, Drew, Linda, Howard, Jennifer and Beth at Huntington Manor

Family members joined us at the Huntington Manor Summer Picnic.


So how does one adjust? I believe there are some key steps:

1. Accept the change. Dwelling on what used to be your life is a sure path to depression. In an earlier post I said I needed to rewrite my life’s script when I learned I had an untreatable, progressively disabling disease. Perhaps now it is time to tear up the script altogether and improvise!

2. Celebrate the advantages. While assisted living may limit your options, it also can improve many aspects of your life, especially if you have been struggling with the activities of daily living. Being helped out of bed, bathed, dressed and fed a nutritious breakfast is a wonderful gift. So is having help available at the push of a button. Cheerful caregivers bring us water and snacks, make sure we get our medicine, drive us to doctors, serve us lunch and dinner on our patio and help us to bed when we are ready.

3. Find purpose. In my case, I’ve taken on the job of building an internet presence for Huntington Manor by updating their website, adding two blogs, one on facility news and one on cooking for the frail elderly, and a Facebook page. I am also dusting off my old php/sql skills to build a database to be used for administration and marketing. I have also given myself the longer term objective of writing one or more books.

Index for this series of articles about assisted living.

Introductory article plus updates.

Is it time for assisted living?

Making the decision to move to assisted living, emotionally, practically and financially.

How we chose the facility we did.

Deciding what to take, what to leave, how to adjust our expectations.

What life in assisted living has been like.

How can we make assisted living better for the physically disabled?

Jun 112012
 

Note: At the time this series of articles was written, my wife Beth was still with us. She died October 11, 2012.

Ceiling Lift installed in my room at Huntington Manor

The owner of Huntington Manor was willing to have my ceiling lift installed.

Once we decided we needed assisted living, there was another choice to make — which facility. We knew the change was going to be huge, whichever facility we chose. so we tried to find as many ways as possible to keep our life intact. This included finding a place not too far away so the overall community would still be familiar to us, and one that would allow us to bring enough personal items to continue our lifestyle as best we could. For example, we both use power wheelchairs and wanted to continue to do so as they give us the independence to travel several miles into the surrounding area. We are both artists and wanted to be able to bring our art supplies and our table. Of course we wanted to remain together for as long as possible.

We did a CANHR (California Advocates for Nursing Home Reform) search and it yielded nearly 700 facilities just for San Diego County. Most are converted single-family homes where they are able to keep six residents, two to a bedroom. Small facilities such as this do not have as restrictive licensing requirements as larger ones and they may be less expensive. For many people this might be a good alternative, however for us they were not appropriate.

Huntington Manor Dining Room

Every few days, before signing a contract, I would roll into the Huntington Manor dining room unannounced.

We needed wide hallways and doorways and adjoining separate rooms to accommodate our large wheelchairs — a physical layout rarely found in a single-family home. Since I cannot help with transfers, I needed a team of caregivers or an overhead lift system. I was also concerned whether a small facility would have the level of care we needed for Beth’s complex medication management and my challenging physical state due to inclusion body myositis.

There are several large assisted living facilities in the county, but they have fire code restrictions that prevent them from accepting non ambulatory residents. Most have associated skilled nursing facilities which is where they suggested I stay, but that would totally restrict my freedom and be very expensive. Also, because our needs were different, the large facilities planned to put my wife and I into two separate buildings.

After eliminating hundreds of facilities, we came upon Huntington Manor, just five miles east, in Poway, California. At 27 residents it was neither large nor small, which for our needs was just right.  It came with good online recommendations and had beautiful surroundings. What really caught my eye was their statement that they accepted nonambulatory patients. Huntington Manor specializes in caring for the frail elderly and has done all of the necessary legal groundwork to be able to accept up to 21 residents who are unable to bear weight. Also, for the first time, I found a facility owner who was willing, even eager, to let me install an overhead lift system in my room.

I stopped by several times, unannounced, to observe the staff and sample the food (friendly, delicious).

A plate of BBQ chicken, carrots and peas

With plates like this, Huntington Manor passed the taste test.

One drawback, which the owner made sure we understood, was the age of the other residents. Most are in their nineties, so we may need to look outside the facility for social interactions.

Price was an issue of course and although Huntington Manor was less expensive than some of the very large facilities, it is still more than we can afford indefinitely. Eventually we will need to sell our home and after that within a few years we’ll need to find some other living arrangement.

In the meantime I am looking for additional sources of income. (Any potential sponsors for this blog site, please take note.)

Index for this series of articles about assisted living.

Introductory article plus updates.

Is it time for assisted living?

Making the decision to move to assisted living, emotionally, practically and financially.

How we chose the facility we did.

Deciding what to take, what to leave, how to adjust our expectations.

What life in assisted living has been like.

How can we make assisted living better for the physically disabled?

May 292012
 

Note: At the time this series of articles was written, my wife Beth was still with us. She died October 11, 2012.

Beth having lunch during our first week at Huntington Manor

Beth having lunch on the deck outside our room during our first week at Huntington Manor

As my weakness from Inclusion Body Myositis became more debilitating and Beth’s vision and cognitive issues worsened, we faced the big question – should we move to assisted living?

There were several aspects to this decision. Perhaps the most easy to evaluate was the financial. Perhaps the most difficult was the emotional.
And then there were family issues, especially children who were tired of worrying about us.

Being the analytical type, I prepared numerous spreadsheets trying to decide whether the move to an assisted living facility made financial sense. I discovered that, to obtain adequate care within our home, we would need to spend about as much as it would cost to get assisted living outside the home. However, there were so many other emotional issues involved that no amount of tweaking the numbers on the spreadsheet seemed to fully resolve the issue in either of our minds.

View from our home in Rancho Bernardo

We had promised ourselves to spend the rest of our years in our Rancho Bernardo home.

We had spent a lot of money on, and had a significant emotional attachment to, the changes we made to our existing home. It was single-story, easy to get around for us in wheelchairs, and had a very nice view out the living room window. We each had our individual art studios on either side of the spacious family room. We would have to say goodbye to all of that. In addition we would be downsizing dramatically from about 1600 ft.² to a little over 500 ft.²

Then there was the concern about our independence. Would we feel as though we were unable to live our own lives if we moved into a facility that had its own schedule and structure?

Eventually, the more I worked on the financial side of it, the more I realized that moving to some form of facility was going to become inevitable. If we remained where we were and continued to spend considerably more money than we had coming in, we would eventually reach the point where we had exhausted our savings and then what? We could sell the home, but then we would hardly have enough resources to maintain us in any other location for more than a few years. On the other hand if we moved and spent down our savings, we could retain our home and rent it, which would provide additional income during that time. Then, when the savings was depleted, we could sell the home and continue to live in the assisted living facility for several more years.

So, ultimately, the practical considerations and family concerns outweighed the emotional worries. How is it working out? Better than we expected. In the next article we will get into the details of how we chose Huntington Manor to be our home – conceivably for the rest of our lives.

Index for this series of articles about assisted living.

Introductory article plus updates.

Is it time for assisted living?

Making the decision to move to assisted living, emotionally, practically and financially.

How we chose the facility we did.

Deciding what to take, what to leave, how to adjust our expectations.

What life in assisted living has been like.

How can we make assisted living better for the physically disabled?

May 152012
 

Note: At the time this series of articles was written, my wife Beth was still with us. She died October 11, 2012.

Mike and Beth touring the English Garden at Huntington Manor Assisted Living.

Mike and Beth touring the English Garden at Huntington Manor Assisted Living.

We are moving to Huntington Manor, an assisted living facility about 5 miles from the single-family home where we have been living for the past six years. This may come as a shock to many who know us and know how fervently I have been clinging to my independence. It comes as an even greater shock to us. However it is not a move that has been made casually. It is the culmination of many months of questioning, analyzing, arguing and soul-searching. The best way to picture what we have been going through is to pretend you are passengers on the Titanic. You’ve been enjoying a spacious stateroom and fine cuisine. Then the iceberg announces itself. You can choose to remain in your comfortable stateroom and hope for the best, or you can fight through the crowds and climb into a lifeboat, with no idea how you will survive that experience. But you know the freezing waters of the North Atlantic are waiting if you make the wrong choice.

For us, that time arrived when we could no longer say that we were each others’ caregivers.

I have been in a wheelchair for 12 years and my wife has been in hers for six. But we have always managed to find a way to be just enough help to one another to get by on our own. Several months ago I began losing what little strength I had in my hands and arms, causing me to stop driving, stop cooking, and start thinking about what to do next.

I am technically classified as “non-ambulatory” and in my case that is an understatement. I cannot walk, I cannot stand, raise my head, or rise to a sitting position without the help of my electric bed. Most assisted living facilities can’t accept a non ambulatory resident. Maybe we should just stay put.

Then at Christmas my wife began having symptoms of a cognitive issue. Whatever is going wrong inside her brain causes her to be very anxious and confused, especially at night. She will get up at two in the morning thinking it is time for her to leave for an appointment. Picture my helplessness lying in bed knowing that I can’t get out before attaching my ceiling lift sling and using it to get into my wheelchair, a process that would take at least half an hour. That is when I realized that it was no longer safe for us to be alone. The waters were rising.

Huntington Manor is an Assisted Living facility in Poway, California

Huntington Manor is an Assisted Living facility in Poway, California

So, back to the search for assisted living. Fortunately we discovered a facility that had been off the radar the first time I looked. It is Huntington Manor, a charming old ranch home that has been converted into a modern assisted living facility with a special emphasis on meeting the needs of the frail elderly. We are neither frail nor elderly but the services they offer are exactly what we need. Best of all, because of their emphasis on an older population, many of their rooms are certified to handle non-ambulatory and bedridden patients – like us.

The owner was very sympathetic to our situation and offered to make some modifications on a new wing of his building to make the transition for us less painful. The most significant change was to give us two rooms at the end of the hall, remove the doors while adding a wall and door in the hall. This lets us be together and also gives us some much needed extra storage space.

Index for this series of articles about assisted living.

Introductory article plus updates.

Is it time for assisted living?

Making the decision to move to assisted living, emotionally, practically and financially.

How we chose the facility we did.

Deciding what to take, what to leave, how to adjust our expectations.

What life in assisted living has been like.

How can we make assisted living better for the physically disabled?